title: Efficacy of total joint arthroplasty in patients with established rheumatoid arthritis: improved longitudinal effects on disease activity but not on health-related quality of life.
abstract: Though excellent clinical results have been reported for total joint arthroplasty (TJA) in rheumatoid arthritis (RA) patients, the longitudinal effects of TJA on pain, physical function, and health-related quality of life in RA patients remain unknown. This study aimed to assess changes in disease activity and health-related quality of life after TJA in patients with established RA. We analyzed the effect of total knee arthroplasty (TKA) and total hip arthroplasty (THA) on RA disease activity in an observational cohort of RA patients. Of the registered RA patients, 333 TKA and 77 THA patients were followed for 5 years after surgery. RA disease activity and health-related quality of life were measured using the Disease Activity Score 28 (DAS28) and a Japanese version of the Stanford health assessment questionnaire (J-HAQ). The mean DAS28 in TKA patients decreased from 4.66 (preoperatively) to 4.02 (3 years postoperatively) and to 3.94 (5 years postoperatively); the mean DAS28 in THA patients decreased from 4.41 (preoperatively) to 3.99 (3 years postoperatively) and to 3.92 (5 years postoperatively). The mean J-HAQ for TKA remained essentially unchanged, ranging from 1.48 (preoperatively) to 1.45 (3 years postoperatively) and to 1.47 (5 years postoperatively); the mean J-HAQ for THA also remained unchanged, ranging from 1.74 (preoperatively) to 1.74 (3 years postoperatively) and to 1.73 (5 years postoperatively). Of the total J-HAQ score, the lower limb score improved while the upper limb score worsened. Although TKA and THA improve clinical outcomes in damaged knees and hips and have a positive secondary systemic effect on RA disease activity, they have not had a continuously good effect on the measures of health-related quality of life. We conclude that tight control of RA disease activity is indicated for those patients with TKA and/or THA.
authors.affiliation: Department of Orthopaedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada, Shinjuku, Tokyo, 162-0054, Japan. smomohara@ior.twmu.ac.jp
authors.forename: Shigeki
authors.initials: S
authors.lastname: Momohara
authors.forename: Eisuke
authors.initials: E
authors.lastname: Inoue
authors.forename: Katsunori
authors.initials: K
authors.lastname: Ikari
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yano
authors.forename: Asami
authors.initials: A
authors.lastname: Tokita
authors.forename: Taku
authors.initials: T
authors.lastname: Suzuki
authors.forename: Yu
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Ryo
authors.initials: R
authors.lastname: Hiroshima
authors.forename: Kosei
authors.initials: K
authors.lastname: Kawakami
authors.forename: Ikuko
authors.initials: I
authors.lastname: Masuda
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwamoto
authors.forename: Atsuo
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamanaka
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome